National Care Service: consultation analysis

7. Commissioning of services

Chapter overview

This section of the consultation addressed the ways in which the National Care Service can embed ethical principles at a local level to deliver support and solutions for better consistency of access, drive up quality and secure person-centredness

Structure of Standards and Processes

A majority of respondents (347 out of the 420 (83%) that responded to this question) thought that a NCS should be responsible for developing a Structure of Standards and Processes. A similar proportion agreed that a Structure of Standards and Processes will help to provide services that support people to meet their individual outcomes. Some thought that local as well as national considerations should be taken into account.

Market research and analysis

A smaller proportion, but still a majority, agreed that a NCS should be responsible for market research and analysis (230 of 368 respondents (63%) agreed). There was no real difference in response between individuals and organisations. Comments here related to the need for independent research and consideration of local circumstances.

National commissioning and procurement processes

A majority also agreed (279 out of the 369 (76%) that responded to this question) that there will be direct benefits in moving the complex and specialist services as set out to national contracts managed by the NCS. Comments here related to the fact that the current system is perceived as disjointed; people should get the same help wherever they are; and the need to maintain an understanding of local needs.

Introduction

The intention of the Scottish Government is that ethical commissioning and procurement will become a cornerstone that the NCS will use to oversee continuity of approach at a local level. This section of the consultation addressed the ways in which the National Care Service can embed ethical principles at a local level to deliver support and solutions for better consistency of access, drive up quality and secure person-centredness. It has three main sections: Structure of Standards and Processes; market research and analysis; and national commissioning and procurement services.

Structure of Standards and Processes

Q67. Do you agree that the National Care Service should be responsible for the development of a Structure of Standards and Processes?

	Individuals	Organisations
Yes	213 (82%)	133 (84%)
No	48 (18%)	25 (16%)
Total	261 (100%)	158 (100%)

There was widespread agreement from the 420 responses to Q67 that the NCS should be responsible for the development of a Structure of Standards and Processes with 83% of respondents in total in agreement. There was no real difference between the responses from individuals and those from organisations. Of those who disagreed, nearly half thought the Community Health and Social Care Boards should be responsible for the Structure of Standards and Processes.

There was also a high level of agreement with the statement that the Structure of Standards and Processes will help to provide services that support people to meet their individual outcomes, with 334 out of the 395 respondents (85%) overall selecting "yes".

A majority of the people who answered Q16 the Easy Read format, (35 out of the 42 (83%)), agreed that the NCS should be responsible for planning and buying services.

Q68. Do you think this Structure of Standards and Processes will help to provide services that support people to meet their individual outcomes?

	Individuals	Organisations
Yes	208 (84%)	125 (86%)
No	41 (17%)	20 (14%)
Total	249 (100%)	145 (100%)

Overall, there were around 100 comments provided for this question. For those that agreed, comments tended to reference consistency of care across Scotland and cost-effectiveness:

"[I] support this to avoid postcode lotteries. My daughter is funded by Scottish Borders whilst her neighbour is funded by Glasgow, my daughter is definitely better provided for than [the] Glasgow person. I don't think this is fair." (Unpaid carer)

"Finance and resourcing is a huge issue which often results in change and restructure to fit what resources are available. This causes inconsistencies and affects efficiency. There needs to be a body which sets the appropriate standards in the hopefully consistent processes being applied." (Organisation respondent)

"We agree that if established, a National Care Service should be responsible for the development of a Structure of Standards and Processes. They should take on a strategic decision-making role, but consider that Scotland Excel would be the appropriate body to carry out national procurement." (Angus Council)

For those that disagreed, key reasons provided included: the need for independence; the risk of overburdening the NCS; and the potential for bureaucracy and duplication.

"It will be a huge endeavour to set up a NCS. It will be easier in the first instance to utilise what is already available. Given that Scotland Excel has a proven track record of national procurement and commissioning it would be easier to set out the expectations for the organisation and expect it to deliver. Once other elements of the NCS are bedded in or established, if Scotland Excel is unable to deliver then the NCS can bring it in house." (Individual respondent)

Q69 Do you think this Structure of Standards and Processes will contribute to better outcomes for social care staff?

A similar proportion of respondents to this question agreed that it will contribute to better outcomes for social care staff (Q69), with 331 of the 393 (84%) respondents to this question agreeing. Individual social workers were slightly less likely to agree, with 40 out of the 54 respondents (74%) in agreement.

Q70. Would you remove or include anything else in the Structure of Standards and Processes?

There were several comments on the Structure of Standards and Processes provided at Q70 although many of the 211 respondents to this question said nothing more was required. These comments mainly related to perceptions that:

• Standards should be outcomes-based
• There should be flexibility to reflect the needs of local populations
• Training and development for staff should be included
• There should be a commitment to continuity and sustainability of services

"The move to an outcomes-focused approach to care and support, with a focus on prevention, is very welcome. We hope that the NCS presents an opportunity to end the regional variation in commissioning and to provide nationally consistent ways of working, where there is absolute consistency in the support that people can expect." (Community Integrated Care)

Some addressed the need to balance national consistency with local flexibility:

"We would like to see a requirement to promote innovation as well as building on the lessons learned from existing good practice. There needs to be a greater emphasis on the importance of balancing consistency at the national level with the importance of a local understanding of context, need and geography for all services, including those for complex and specialist services." (Care Inspectorate)

"Enshrine local as well as national considerations in all commissioning and procurement processes." (North East Sensory Services (NESS))

Several respondents noted that commissioning should not only be driven by the cost or the "bottom line":

"An ethical commissioning and procurement approach must include more than the bottom line. It must include Fair Work, terms and conditions, and aim to measure value delivering a fairer, outcomes focused, empowering social care support system that strives for continual improvement, participation and collaboration and delivers for all, those who need social care support and those who deliver it." (Alzheimers Scotland).

There were also a few comments around the current commissioning arrangements and the role of Scotland Excel:

"Local Authorities already have the option to participate in national contracts and framework agreements through Scotland Excel or they can choose to develop their own local solutions. This approach recognises that there is not a one size fits all approach to the delivery of key social work and social care services and that many services that impact on a person's health and wellbeing require wider linkages with areas such as housing, employability, education, public safety and protection." (West Lothian Council)

"We fail to understand why the Scottish Government would not build upon, and resource appropriately, Scotland Excel who have extensive skills and experience in commissioning at a national and local level. The discussion here should be about adequate resourcing for ethical commissioning rather than the view that the current commissioning is failing." (Organisation respondent)

Market research and analysis

Q71 Do you agree that the National Care Service should be responsible for market research and analysis?

A majority of respondents to the question on whether the NCS should be responsible for market research and analysis, 230 out of the 368 (63%) who responded to this question, agreed that it should (Q71). There was no real difference between organisations (85 out of 134 respondents (63%)) and individuals (145 out of 233 respondents (62%)) who responded to this question.

For those that disagreed (138 out of 368 respondents (38%)), other suggestions included the CHCSBs and the Care Inspectorate, but these were selected by a relatively small number of respondents (25 for each). There were 158 text responses to this question. Most of the comments provided at this question were broadly related to:

• The need for independent research
• Consideration of the local perspective
• The benefits of including academia and other partners
• The benefits of greater data sharing between relevant bodies to improve planning processes

"[It] should be aligned with and supported with academic research." (Individual respondent)

"A national approach makes sense for wider national needs but this risks losing the local differences and requirements which should come under the CHSCB." (Social worker)

The Scottish Association of Social Work (SASW) highlighted the work that has been done over a number of years to improve information gathering and sharings and noted the risk that these advances may be lost in a new system. In its submission, the SASW suggests that a less siloed approach will help strategic planning:

"One of the challenges across social services has been the lack of a national overview of intersecting data that together, if analysed, would give a fuller and more accurate picture of demand patterns. This should influence and guide commissioning and purchasing arrangements. Currently this data remains within each individual organisation with limited sharing facilitated through the Integration Joint Board structure. The lack of information and data sharing has restricted long term strategic planning aspirations and affected commissioning and procurement processes." (Scottish Association of Social Work)

National commissioning and procurement services

There were over 360 respondents to the question regarding whether there will be direct benefits in moving the complex and specialist services, such as; care for people whose care needs are particularly complex and specialist, custodial settings including prison, residential care homes and care home contracts, to national contracts managed by the NCS (Q72). Of these, 279 out of the 369 respondents (76%) were in agreement. A small number (44 out of 76 respondents (58%)) suggested the CHCSBs.

Q72. Do you agree that there will be direct benefits for people in moving the complex and specialist services as set out to national contracts managed by the National Care Service?

	Individuals	Organisations
Yes	185 (78%)	93 (71%)
No	51 (22%)	39 (30%)
Total	236 (100%)	132 (100%)

Two thirds of respondents to the Easy Read questionnaire agreed that it would benefit people if complex and specialist services are managed by the NCS (25 out of the 39 respondents (64%)). Over a quarter had no preference (Q17).

Overall, comments in relation to this question referenced themes such as:

• The system is not currently working and is somewhat disjointed
• People should get the same help wherever they are
• There is a need to maintain local knowledge
• There needs to be clarity about how the proposals will be resourced financially, including for third sector involvement